What is Shoulder Impingement?
Subacromial impingement is a syndrome that refers to the pinching (impingement) of the tendons of the rotator cuff between the humeral head and the acromion process of the shoulder blade. This repetitive pinching causes inflammation and swelling in the shoulder resulting in shoulder pain. Irritation of the tendons and subacromial bursitits (inflammation of the fluid filled sac called the bursa) may result from the process. As the inflammation progresses, the symptoms become more frequent and more severe.
This type of shoulder injury is often caused by chronic overuse resulting in bone spurs that can develop in the area and symptoms will be felt most when reaching and performing overhead activities. Other patients may be predisposed to developing subacromial impingement because of an abnormal shape of their bone(s) or a previous traumatic injury to the shoulder. This is most common in patients over 30 years of age, but may be seen in any age patient. Another factor is weakness of the muscles around the shoulder blade, which cause it to sit in an inappropriate position and may predispose patients to developing impingement. In certain cases, subacromial impingement may be associated with biceps tendonitis and/or rotator cuff tearing. Shoulder specialist, Dr. Robert Boykin focuses on treating patients in Asheville, Arden, Fletcher and surrounding North Carolina communities who have subacromial impingement.
Symptoms of Shoulder Impingement
Symptoms associated with subacromial impingement are as follows:
- Sharp pain felt on the front or outside of the shoulder with overhead activity
- Overall weakness of the affected shoulder secondary to pain
- Pain or grinding noted with activities of daily living or overhead activity
How to Diagnosis Subacromial Impingement
Before a treatment method can be decided upon, Dr. Boykin will perform a series of examinations and tests in order to properly diagnosis the injury. This will include a detailed history, physical exam, and X-rays. Physical exam tests to assess for impingement include the impingement tests of Neer and Hawkins. In certain cases a MRI scan may be ordered to differentiate between impingement with rotator cuff tendonitis (inflammation of the tendon) or a rotator cuff tear.
First Options for Treating Subacromial Impingement
In cases of subacromial impingement Dr. Boykin usually prefers to attempt non-surgical methods first, as in many cases the injury can be adequately treated without an operation. The pain and inflammation caused by the syndrome can be reduced and possibly even resolve by rest, anti-inflammatory medications, and appropriate physical therapy. In cases with continued pain, an injection of corticosteroids to the subacromial bursa may help alleviate pain and allow the patient to make progress with physical therapy and accomplish longstanding relief. In more serious cases or those that have failed the above mentioned non-operative measures, Dr. Boykin may recommend a surgical treatment.
Surgical Treatment for Subacromial Impingement
In the surgical treatment of nearly all cases of subacromial impingement, Dr. Boykin will perform an arthroscopic surgical approach. This surgery is performed through several very small incisions through which a camera and special surgical instruments are inserted. During this operation the rotator cuff is visualized to make sure there is no tearing. The area of inflammation in the subacromial bursa is then removed. The bone spurs causing the pinching are then also removed and the entire area is smoothed down to allow normal, pain-free motion.
For more information on subacromial impingement, or to discuss your shoulder pain and shoulder injury with Dr. Robert Boykin, please contact his Asheville, Arden, Fletcher and surrounding North Carolina communities, orthopedic practice.